Background Check Forms

ALL PROGRAMS

Caregiver Background Checks:

Background Information Disclosure and Instructions (BID)

Wisconsin Department of Justice (exit DHS) to access the following forms and instructions for completing them:

  • Wisconsin Criminal History Single Name Record Request Form DJ-LE-250
  • Wisconsin Criminal History Multiple Name Record Request Form DJ-LE-250A
  • Wisconsin Criminal History Account Application Form DJ-LE-251

Health Care Providers Only: DQA Regulated EntityBackground Check Process

Rehabilitation Review:

  • Rehabilitation Review Request Instructions and Form, F-83263 (PDF 42 KB), for a caregiver required pursuant to Ch. DHS 12 (exit DHS; PDF 40 KB) to prove rehabilitation.
  • Counties, school boards, child placing agencies and tribes may order the forms to report rehabilitation review panel decisions to the Department of Health Services. See Ordering Printed Forms for the following:
    • Rehabilitation Review Panel Decision Report, F-83264
    • Instructions for Rehabilitation Review Panel Decision Report, F-83264A
    • Rehabilitation Review Appeals Report, F-83265
    • Instructions for Rehabilitation Review Appeals Report, F-83265A
Last Revised: January 5, 2015